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Call for clampdown on antipsychotic prescribing

By Lilian Anekwe

Psychiatrists are demanding that GPs should audit their prescribing of antipsychotics to patients with dementia every three months, as part of a Government clampdown on inappropriate use of the drugs.

The Royal College of Psychiatrists told a Department of Health consultation that GPs ‘lacked expertise' in managing dementia and needed to regularly review every one of their prescribing decisions for patients with the illness.

The DH consultation was launched last summer after a spate of studies suggested prescribing of antipsychotics in patients with dementia was increasing their risk of falls, hospital admissions and mortality.

The publication of the Government's review has been delayed from October, but ministers have now collated submissions by the Royal College of Psychiatrists and the RCGP, both of which call for more frequent reviews of GPs prescribing.

The response from the Royal College of Psychiatrists states: ‘GPs confirm their lack of expertise yet receive QOF payments for maintaining a case register and reviewing patients within 15 months.'

Instead, it calls for: ‘Three monthly reviews and recorded decisions for every dementia patients on a primary care register. Reward would be contingent on the register have a high proportion of locally estimated cases on the register.'

Dr Dave Anderson, who drafted the submission in his role as chair of the college's old age faculty, told Pulse: ‘Evidence shows most of the disturbance in dementia is transient but patients are put on antipsychotics for far too long. There should be some requirement for three-monthly drug reviews and that might be something that is a QOF requirement, and we have made that recommendation to the DH.'

Three-monthly reviews would ensure ‘prescribing would go down to a level more commensurate with what we know it should be', Dr Anderson added.

The RCGP called for repeat prescribing and monitoring systems to be ‘tightened up', and argued for ‘half-yearly audits of prescribing of antipsychotics in dementia by the PCT'.

Dr Mark Morris, a GP in Falmouth, Cornwall with an interest in mental health and dementia, said: ‘GPs are a little bit stuffed when it comes to dementia. There's a real world consideration – a person with behavioural problems that puts them at risk. The guidance tells us we should not really do anything but in the real world you have to do something.'

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